Article

Bladder and bowel management may cause serious autonomic dysreflexia (AD) in subjects with
high spinal cord injury (SCI).
We aimed at investigating autonomic responses to
digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and
filling cystometry (FC) in SCI. SETTING: Aarhus University Hospital, Denmark.
METHODS: Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous
history of AD were compared with three subjects with SCI (AIS A) between T10 and
L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined
as an acute rise in systolic blood pressure (sBP) of 30 mm Hg above baseline.
Blood levels of norepinephrine and epinephrine were determined before and shortly
after the procedures. RESULTS: During all three procedures, AD occurred in all
patients with high SCI but not in those with low SCI. In high SCI subjects, DE
increased median sBP from 127 (range: 86-154) to 188 (range: 140-206) mm Hg
(P<0.02), TAI from 126 (range: 91-146) to 163 (range: 130-188) mm Hg (P<0.02) and
FC from 125 (range: 106-149) to 200 (range: 179-220) mm Hg (P<0.01). The sBP
increase was lower during TAI than during DE (P<0.05) or FC (P<0.02). In high SCI
subjects, the blood levels of norepinephrine, but not those of epinephrine,
increased significantly during all three stimuli (all P<0.05). CONCLUSION: Bowel
and bladder management caused AD in high SCI. The response is less severe during
TAI than during FC or DE.

Langue : ANGLAIS